Stillbirth: Unheard cry of newborns

Background: Stillbirths are tragic but not uncommon. Although five times more common than sudden infant death, stillbirths yet to attract adequate public health focus.

Methods: A cluster-randomized study, conducted in Sylhet, Bangladesh during 2002-2006 with aim to reduce neonatal mortality at community level used female community health workers to make home visits to promote birth and newborn care preparedness during pregnancy; to visit the newborn and recently delivered women immediately after delivery, and if possible during delivery; to assess newborn’s health in early neonatal period and refer or treat sick newborns. Community level counseling sessions were conducted to promote awareness about the importance of proper antenatal care, delivery care, postpartum maternal care, and newborn care. Using end-line survey data, logistic regression was employed here to assess the association between events of stillbirths and taking any emergency birth preparation step and using skilled delivery attendant.

Results: Of the 6,287 women, 62% had complication during pregnancy and/or during delivery; 26% took at least one birth and newborn care preparation step and 15.3% used skilled delivery attendant. In unadjusted analysis, women who took any birth and newborn care preparation step were 20% less likely to have stillbirth [OR: 0.21; 95% CI: 0.15-0.27; p>0.001]; women who had skilled delivery attendant were 57% less likely to had stillbirth [OR: 0.21; 95% CI: 0.36-0.90; p=0.019]; and women who delivered with space of less than 18 months after the previous delivery were 71% more likely to had stillbirth [OR: 1.71; 95% CI: 1.17-2.50; p=0.008]

Conclusion: Stillbirth is a major public health problem, accounting for a greater contribution to perinatal mortality. Research into the underlying mechanisms and etiological factors of this problem to identify pregnancies at risk must remain a prerequisite for any strategic discussion to prevent these tragic deaths.